Cigarette smoking and gastric cancer in the Stomach Cancer Pooling (StoP) Project

Praud, Delphine; Rota, Matteo; Pelucchi, Claudio; Bertuccio, Paola; Rosso, Tiziana; Galeone, Carlotta; Zhang, Zuo‐Feng; Matsuo, Keitaro; Ito, Hidemi; Ji, Hu; Johnson, Kenneth C.; Gao, Yu; Palli, Domenico; Ferraroni, Monica; Muscat, Joshua E.; Lunet, Nuno; Peleteiro, Bárbara; Malekzadeh, Reza; Ye, W.; Song, Huan; Заридзе, Давид; Maximovitch, Dmitry; Aragonés, Núria; Castaño‐Vinyals, Gemma; Vioque, Jesús; Navarrete-Muñoz, Eva María; Pakseresht, Mohammadreza; Pourfarzi, Farhad; Wolk, Alicja; Orsini, Nicola; Bellavia, Andrea; Håkansson, Niclas; Mu, Lina; Pastorino, Roberta; Kurtz, Robert C.; Derakhshan, Mohammad H.; Lagiou, Areti; Λάγιου, Παγώνα; Boffetta, Paolo; Boccia, Stefania; Negri, Eva; Vecchia, Carlo La

doi:10.1097/cej.0000000000000290

Cited by 162 publications

(109 citation statements)

References 47 publications

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“…The disparities in GC risk among socioeconomic classes have been attributed to the uneven distribution of lifestyle risk factors for GC that favors people in the highest SEP, with differences in smoking, alcohol drinking and dietary habits being thought to play a major role. However, when we adjusted for these risk factors, the magnitude of the association remained strong, suggesting that the reduced risk of GC associated with a high SEP operates through more complex pathways than those related to modifiable risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…42 A strong inverse association emerged also in a recent large longitudinal Italian census-based study reporting reduced mortality among highly educated individuals in both sexes, with standardized mortality ratio of 0.41 in men and 0.50 in women for the highest compared to the lowest level of education. 8 The disparities in GC risk among socioeconomic classes have been attributed to the uneven distribution of lifestyle risk factors for GC that favors people in the highest SEP, with differences in smoking, 44 alcohol drinking 45 and dietary habits 46 being thought to play a major role. However, when we adjusted for these risk factors, the magnitude of the association remained strong, suggesting that the reduced risk of GC associated with a high SEP operates through more complex pathways than those related to modifiable risk factors.…”

Section: Discussionmentioning

confidence: 99%

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Education and gastric cancer risk—An individual participant data meta‐analysis in the StoP project consortium

Rota

Alicandro

Pelucchi

et al. 2019

Intl Journal of Cancer

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Low socioeconomic position (SEP) is a strong risk factor for incidence and premature mortality from several cancers. Our study aimed at quantifying the association between SEP and gastric cancer (GC) risk through an individual participant data meta‐analysis within the “Stomach cancer Pooling (StoP) Project”. Educational level and household income were used as proxies for the SEP. We estimated pooled odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) across levels of education and household income by pooling study‐specific ORs through random‐effects meta‐analytic models. The relative index of inequality (RII) was also computed. A total of 9,773 GC cases and 24,373 controls from 25 studies from Europe, Asia and America were included. The pooled OR for the highest compared to the lowest level of education was 0.60 (95% CI, 0.44–0.84), while the pooled RII was 0.45 (95% CI, 0.29–0.69). A strong inverse association was observed both for noncardia (OR 0.39, 95% CI, 0.22–0.70) and cardia GC (OR 0.47, 95% CI, 0.22–0.99). The relation was stronger among H. pylori negative subjects (RII 0.14, 95% CI, 0.04–0.48) as compared to H. pylori positive ones (RII 0.29, 95% CI, 0.10–0.84), in the absence of a significant interaction (p = 0.28). The highest household income category showed a pooled OR of 0.65 (95% CI, 0.48–0.89), while the corresponding RII was 0.40 (95% CI, 0.22–0.72). Our collaborative pooled‐analysis showed a strong inverse relationship between SEP indicators and GC risk. Our data call for public health interventions to reduce GC risk among the more vulnerable groups of the population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Education and gastric cancer risk—An individual participant data meta‐analysis in the StoP project consortium

Rota

Alicandro

Pelucchi

et al. 2019

Intl Journal of Cancer

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“…The increased risk seen with smoking and stomach cancer in this study is higher than that reported in a meta-analysis of cohort studies that compared former vs never smokers in males RR 1.42; 95%CI 1.21–1.67) [27] and a meta-analysis of 10,290 cases and 26,145 controls which reported a pooled OR of 1.12 (95%CI 0.99–1.27) for former and OR 1.25 (95%CI 1.11–1.40) for current smokers compared to never smokers [28]. We assessed the impact of SEP as a confounder on our results (S1 Table) which show a reduced OR in ex-smokers from 2.26 (95%CI 1.44–3.54) to 1.98 (95%CI 1.25–3.14) and in current smokers, from OR 1.46 (95% CI 0.86–2.48) to OR 1.15 (95%CI 0.67–1.99).…”

Section: Discussionmentioning

confidence: 99%

“…Positive associations between tobacco smoking and stomach cancer have been reported [27–28]. Māori have had some of the highest smoking rates in the world and begin smoking at an earlier age than other populations [29–30].…”

Section: Introductionmentioning

confidence: 99%

Risk of stomach cancer in Aotearoa/New Zealand: A Māori population based case-control study

et al. 2017

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Māori, the indigenous people of New Zealand, experience disproportionate rates of stomach cancer, compared to non-Māori. The overall aim of the study was to better understand the reasons for the considerable excess of stomach cancer in Māori and to identify priorities for prevention. Māori stomach cancer cases from the New Zealand Cancer Registry between 1 February 2009 and 31 October 2013 and Māori controls, randomly selected from the New Zealand electoral roll were matched by 5-year age bands to cases. Logistic regression was used to estimate odd ratios (OR) and 95% confidence intervals (CI) between exposures and stomach cancer risk. Post-stratification weighting of controls was used to account for differential non-response by deprivation category. The study comprised 165 cases and 480 controls. Nearly half (47.9%) of cases were of the diffuse subtype. There were differences in the distribution of risk factors between cases and controls. Of interest were the strong relationships seen with increased stomach risk and having >2 people sharing a bedroom in childhood (OR 3.30, 95%CI 1.95–5.59), testing for H pylori (OR 12.17, 95%CI 6.15–24.08), being an ex-smoker (OR 2.26, 95%CI 1.44–3.54) and exposure to environmental tobacco smoke in adulthood (OR 3.29, 95%CI 1.94–5.59). Some results were attenuated following post-stratification weighting. This is the first national study of stomach cancer in any indigenous population and the first Māori-only population-based study of stomach cancer undertaken in New Zealand. We emphasize caution in interpreting the findings given the possibility of selection bias. Population-level strategies to reduce the incidence of stomach cancer in Māori include expanding measures to screen and treat those infected with H pylori and a continued policy focus on reducing tobacco consumption and uptake.

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“…Our study is based on the second data release of the StoP project consortium (http://www.stop-project.org/), which included 31 case–control studies of gastric cancer conducted worldwide. Detailed information on the aims and methods of the StoP project has been given elsewhere . Participating studies were involved through personal contacts of participating investigators.…”

Section: Methodsmentioning

confidence: 99%

Citrus fruit intake and gastric cancer: The stomach cancer pooling (StoP) project consortium

Bertuccio

Alicandro

Rota

et al. 2019

Intl Journal of Cancer

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Diets rich in vegetables and fruit have been associated with reduced risk of gastric cancer, and there is suggestive evidence that citrus fruits have a protective role. Our study aimed at evaluating and quantifying the association between citrus fruit intake and gastric cancer risk. We conducted a one‐stage pooled analysis including 6,340 cases and 14,490 controls from 15 case–control studies from the stomach cancer pooling (StoP) project consortium. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) of gastric cancer across study‐specific tertiles of citrus fruit intake (grams/week) were estimated by generalized linear mixed effect models, with logistic link function and random intercept for each study. The models were adjusted for sex, age, and the main recognized risk factors for gastric cancer. Compared to the first third of the distribution, the adjusted pooled OR (95% CI) for the highest third was 0.80 (0.73–0.87). The favourable effect of citrus fruits increased progressively until three servings/week and leveled off thereafter. The magnitude of the association was similar between cancer sub‐sites and histotypes. The analysis by geographic area showed no association in studies from the Americas. Our data confirm an inverse association between citrus fruits and gastric cancer and provide precise estimates of the magnitude of the association. However, the null association found in studies from America and in some previous cohort studies prevent to draw definite conclusions on a protective effect of citrus fruit consumption.

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Cigarette smoking and gastric cancer in the Stomach Cancer Pooling (StoP) Project

Cited by 162 publications

References 47 publications

Education and gastric cancer risk—An individual participant data meta‐analysis in the StoP project consortium

Education and gastric cancer risk—An individual participant data meta‐analysis in the StoP project consortium

Risk of stomach cancer in Aotearoa/New Zealand: A Māori population based case-control study

Citrus fruit intake and gastric cancer: The stomach cancer pooling (StoP) project consortium

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